2021 National Conference Planning Materials

November 13-15, 2021 Online Conference

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Table of Contents

General Page

Table of Contents 2 Mee0ng Schedule 3 - 5 Program Objec0ves 6

Saturday Instruc0on Course Abstracts 8 - 9

Sunday AACO Business Mee0ng 4, 7 Scien0fic Session I Abstracts 9 - 10 Scien0fic Session II Abstracts 11 - 12 Lancaster Award Presenta0on 4

Monday Scien0fic Session III Abstracts 12 - 13 Richard G. Scobee Memorial Lecture 14 - 16 Scien0fic Session IV Abstracts 16 - 17 Scien0fic Session V Abstracts 17 - 18

On Demand AAO/AOC/AACO Sunday Symposium Schedule 19 AAO/AOC/AACO Sunday Symposium Abstract 19

General Informa6on Con0nuing Educa0on Credits 20 AACO Officers and Representa0ves 21 AACO CommiWee Chairpersons 21 - 22 Index of Authors 22 - 23 Future Mee0ngs 24 AACO Sponsors 25

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AACO Na6onal Mee6ng 2021 Schedule

*Times listed in EST

Saturday, November 13th, 2021

Instruc0on Courses

11:00 AM - 1:15 PM Instruc6on Courses I 11:00 AM The U6lity of OCT Ganglion Cell Measurement in Visual Pathway Disorders Mitch Strominger, MD 11:30 AM How to Not Miss a Pediatric Brain Tumor Jane Edmond, MD 12:30 PM The Quick Pivot to Telemedicine Kaajal Nanda, BMed Sci, CO 1:00 PM Discussion

1:15 PM Break

1:30 PM - 3:30 PM Instruc6on Courses II 1:30 PM Gene6cs and Ocular Syndromes Ron Biernacki, CO 2:00 PM The Big Easy Method for Analyzing Medical Literature Kyle Arnoldi CO, Jocelyn Zurevinsky OC(C), Linda Colpa OC(C), Jim Reynolds MD, Burton Kushner MD, Sally Murray CO, Cindy Pritchard CO 3:00 PM Round Table with the Research Experts FOREA Research Experts 3:15 PM Discussion

3:30 PM - 4:15 PM Break

4:15 PM - 5:45 PM Instruc6on Courses III 4:15 PM Accommoda6ve Esotropia Greater at Near Fixa6on: Can a Patch Test Differen6ate a Novel Subtype? Cindy Pritchard, CO, COT, J. Reeves Ellis Samaha, MD, MPH George S. Ellis, Jr, MD 4:30 PM Nystagmus Workshop: Case Presenta6ons and Discussion Gena Heidary MD PhD, Kaila Bishop OC(C) COMT, Jessica Carr OC(C) COMT, Kristyn Magwire CO, Veronica Ton COA, Peyton Hundley 5:30 PM Discussion

5:45 PM Adjourn

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Sunday, November 14th, 2021

Scien0fic Sessions

11:00 AM - 1:00 PM AACO Business Mee6ng

1:00PM - 1:30 PM Break

1:30 PM - 2:45 PM Scien6fic Session I 1:30 PM The Future is all about The History Wanda Pfeifer, OC(C),COMT,CO 1:45 PM Guaranteeing Competence - Introducing Competencies into Orthop6c Training Programs Dusty Gronemyer, CO, Douglas Fredrick, MD 2:00 PM Obstacles in Clinical Educa6on in Orthop6cs: A Survey of Medical and Program Directors Wanda Pfeifer, OC(C),COMT,CO 2:15 PM The Flipped Classroom Approach to Teaching Basic Science Classes in Orthop6c Fellowship Dusty Gronemyer, CO, Kim Merrill, CO, Jessica Tegeler, CO 2:30 PM Discussion

2:45 PM - 3:30 PM Break

3:30 PM - 4:30 PM Scien6fic Session II

3:30 PM Single Horizontal Rectus Muscle Ver6cal Augmented Transposi6on with Posterior Fixa6on Suture in Management of Monocular Eleva6on Deficiency Federico Velez, MD 3:45 PM Inter-observer Reliability of the Prism Vergence Test Alexandra Sherven, OC(C) 4:00 PM Is there Agreement between Near and Distance Fixa6on for Secondary Posi6on Measurements? Jocelyn Zurevinsky, OC(C) 4:15 PM Discussion

4:30 PM Lancaster Award Presenta6on

4:35 - 4:50 PM Break

4:50 PM - 6:00 PM AACO Regional Mee6ngs

6:00 PM Adjourn

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Monday, November 15th, 2021

Scien0fic Sessions

11:00 AM - 12:15 PM Scien6fic Session III 11:00 AM Levels of As6gma6sm and Anisometropia in Congenital Ptosis Kaajal Nanda, BMed. Sci., CO, Jenny Yu, MD 11:15 AM Ocular Findings Associated with the L1CAM Muta6on Katrina Callus, BA, COT, OSC 11:30 AM How Much Strabismus Can You Have and Become a Pilot in the Air Force? Rhea Nelson, CO 11:45 AM Crescendo - Decrescendo Ka0e Tullar, 2nd year Orthop0c Student 12:00 PM Discussion

12:15 PM - 12:30 PM Break

12:30 PM - 1:30 PM Scobee Memorial Lecture and Award Presenta6ons Dr. Stephen Chris0ansen MD

1:30 PM - 2:30 PM Break

2:30 PM - 3:45 PM Scien6fic Session IV 2:30 PM Moebius Syndrome with Aberrant Convergence Shelley Klein, CO, COMT 2:45 PM Inferior Oblique Over-Ac6on a^er Cranial Nerve Six Palsy Gabriella Waldusky, Orthop0c Student, Kim Merrill, CO 3:00 PM Interpreta6on and Management of Acquired Convergence Dysfunc6on Gill Roper-Hall, DBOT, CO 3:30 PM Discussion

3:45 PM - 4:00 PM Break

4:00 PM - 5:00 PM Scien6fic Session V 4:00 PM Norma6ve Values, Testability, and Validity for a New Preferen6al Looking Stereoacuity Test Sarah Morale, BS 4:15 PM Reliability of Visual Acuity Using the Home Vision Check Kit Developed at the University of Minnesota Anna Schweigert, CO 4:30 PM Graded Marginal Myotomy for Minimally Overac6ng Inferior Oblique Jonathan Russell, CO, MBA 4:45 PM Discussion

5:00 PM Adjourn

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Target Audience

Orthop0sts, orthop0c students, ophthalmic technicians with experience in pediatric or neuro-ophthalmology, pediatric and neuro-ophthalmologists, residents, and fellows.

Course Level

Intermediate to advanced.

Overall Program Objec9ves

Educa0onal Objec0ves: at the conclusion of the Na0onal Mee0ng, par0cipants will be able to:

● Describe recent medical advances in the diagnosis, treatment, and management of condi0ons encountered while prac0cing orthop0cs within the pediatric ophthalmology and adult strabismus community.

● Apply improved techniques, use methods to compare and contrast current prac0ces, and cri0cally review empirical clinical research in order to provide the best possible treatment op0ons for pa0ents with strabismus and disorders of ocular mo0lity and binocular vision.

● Demonstrate methods of analysis and ethical treatment of pa0ents. ● Prac0ce orthop0cs with a new-found exper0se based upon new methods discussed and

demonstrated.

Specific Program Objec9ves

To review current therapies and new advances in diagnosis and management of diseases in each area of orthop0cs, pediatric ophthalmology, and strabismus with par0cular emphasis on the following topics:

● Pediatric and Adult strabismus ● Amblyopia ● Analyzing medical literature ● Topics in Neuro-ophthalmology ● Diplopia ● Clinical Educa0on in Orthop0cs ● Strabismus Surgery

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ATTENTION ALL AACO MEMBERS: Our future needs YOU!

Sunday, November 14, 2021, 11:00am – 1:00pm EASTERN STANDARD TIME

AACO NATIONAL BUSINESS MEETING

AACO Members will have access to the Business Meeting through the Online Learning Center. The lecture sessions and the Business Meeting will show up

under separate categories. If you do not see it listed, make sure you are logged in (top right side of the webpage).

Online Learning Center: hWps://aaco.mclms.net/en/

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Instruction Course Abstracts Saturday, November 13th, 2021

11:00 AM – 5:45 PM EST

The U6lity of OCT Ganglion Cell Measurement in Visual Pathway Disorders Mitch Strominger, MD 11:00 AM – 11:30 AM Measuring the Ganglion Cell layer is now available when obtaining an OCT of the macula. This curious measurement is now supplying informa0on on op0c pathways disorders never seen before or thought to exist. This talk will discuss how to obtain the ganglion cell layer, how to interpret the results and how to correlate with visual pathway disorders. How Not to Miss a Pediatric Brain Tumor Jane Edmond, MD 11:30 AM - 12:30 PM This course will provide, via authen0c (and ojen misdiagnosed) pa0ent cases, an overview of the common intracranial tumors and their poten0al impact on the visual pathway. Tumors discussed will include op0c pathway glioma, craniopharyngioma and cerebellar tumors.

The Quick Pivot to Telemedicine Kaajal Nanda, BMed. Sci., CO 12:30 PM – 1:00 PM This course is aimed to reflect on the challenges ophthalmology faced in the peak of COVID-19, and the ways in which we overcame them. The steps taken to create and adapt to telemedicine within ophthalmology and correc0on of various faults along the way, will be discussed.

Gene6cs and Ocular Syndromes Ron Biernacki, CO 1:30 PM - 2:00 PM This course will discuss basic gene0c terminology and look at different ocular syndromes and their manifesta0ons.

The Big Easy Method for Analyzing Medical Literature Kyle Arnoldi CO, Jocelyn Zurevinsky OC(C), Linda Colpa OC(C), Jim Reynolds MD, Burton Kushner MD, Sally Murray CO, Cindy Pritchard CO 2:00 PM - 3:00 PM To maintain and advance professional excellence, the orthop0st must stay abreast of the ever-growing body of research in the field. This is the essence of con0nuing educa0on and the founda0on of evidence-based medicine. Sources include oral and poster presenta0ons at scien0fic conferences, but these can be expensive or inconvenient to aWend. The primary source of new informa0on, therefore, should be the peer-reviewed publica0on. To be a peer-reviewer, one must develop skills as a cri0cal reader of the literature. It is a professorial skill that serves the academic and clinical community, while simultaneously advancing the knowledge and professional status of the reviewer. The learning curve may seem steep, but you are not climbing the mountain alone. And reaching the summit is well worth the effort! In this workshop, a panel of experienced writers and reviewers from the Journal of Binocular Vision and Ocular Mo0lity will break down the process of dissec0ng different types of ar0cles, with the objec0ves of both gaining insight and beWering the manuscript. To do this, we will review individual sec0ons of manuscripts together, in real 0me.

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Accommoda6ve Esotropia Greater at Near Fixa6on: Can a Patch Test Differen6ate a Novel Subtype? Cindy Pritchard, CO, COT, J. Reeves Ellis Samaha, MD, MPH George S. Ellis, Jr, MD 4:15 PM - 4:30 PM The preliminary results of 65 pa0ents with accommoda0ve esotropia who underwent a 20-minute monocular patch test (Marlow occlusion) will be presented. We compared alternate prism and cover test measurements at distance and near before and ajer the Marlow occlusion with aWen0on to changes in distance/near disparity. The hypothesis was that there might be a sub-group of pa0ents that show a collapse in the distance/near disparity following Marlow occlusion. The preliminary results show that 48% of subjects with distance/near disparity 10^ or greater had a collapse in the distance near disparity following Marlow occlusion. All study pa0ents are being followed to determine if response to Marlow occlusion is predic0ve of clinical course and outcome with regard to needing a bifocal, ability to eliminate the bifocal or a need for surgical interven0on.

Nystagmus Workshop: Case Presenta6ons and Discussion Gena Heidary MD PhD, Kaila Bishop OC(C) COMT, Jessica Carr OC(C) COMT, Kristyn Magwire CO, Veronica Ton COA, Peyton Hundley 4:30 PM - 5:30 PM This case-based workshop will present and discuss clinical nystagmus cases of varying e0ology and complexity. All cases have presented to the pediatric ophthalmology and strabismus clinic. Focus will be on ini0al diagnosis, course of treatment and long term outcome for these pa0ents. Cases will be presented to a pediatric Neuro-ophthalmologist to allow for an expert opinion on diagnosis and management.

AACO Scientific Session I Abstracts Sunday, November 14th, 2021

1:30 PM – 2:45 PM The Future is all about the History Wanda Pfeifer, OC(C), COMT, CO 1:30 PM - 1:45 PM This interac0ve, fun presenta0on about events in AACO history will not only test your knowledge but get you thinking about how far we have come as an organiza0on and where we might grow in the future.

Guaranteeing Competence- Introducing competencies into Orthop6c training programs Dusty Gronemyer, CO, Douglas Fredrick, MD 1:45 - 2:00 PM As orthop0st play a larger role in the provision of care for children and adults with ocular and vision disorders, it is essen0al that our new graduates have demonstrated competency in the realms of knowledge, pa0ent care and communica0on. The Accredita0on Council for Graduate Medical Educa0on (ACGME) has defined 6 competencies in which all physicians in training must demonstrate achievement of specific milestones as a requirement for gradua0on. In this presenta0on we will discuss how adop0on of these competencies into Orthop0c training programs will allow for standardiza0on of assessment and ensure the public and accredita0on organiza0ons that we are training competent orthop0sts who will deliver excellent care for pa0ents of all ages.

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Obstacles in Clinical Educa6on in Orthop6cs: A Survey of Medical and Program Directors Wanda Pfeifer, OC(C), COMT, CO 2:00 - 2:15 PM In 2020, the American Orthop0c Council (AOC) celebrated 85 years of establishing standards and guidelines for the educa0on and ethical conduct of orthop0sts in the United States. The AOC has been responsible for seqng and monitoring standards for educa0on of orthop0sts and reviews and grants accredita0on to orthop0c programs in the United States. As we aWempt to move towards licensure, improving and promo0ng the quality of clinical educa0on entails evalua0on of the perceived obstacles and then devising plans to address these weak points. The instructors and program directors having once been students and now preceptors are in an ideal posi0on to help iden0fy these obstacles. Medical directors and program directors deal with administra0ve obstacles on a local as well as na0onal level thus can also offer a differing viewpoint. Purpose: The purpose of this study was to develop a survey specific to orthop0cs that focused on iden0fying clinical obstacles in teaching and determine if program and medical director share the same views on the obstacles in clinical teaching of orthop0c students.

Methods: The Obstacles of Clinical Educa0on Survey in Orthop0cs (OCESO) consisted of mostly closed and semi closed ques0ons using a 5-point Likert scale. The survey asked about obstacles to clinical educa0on in four main areas, (1) director and preceptor related obstacles, (2) management obstacles, (3) pa0ent/clinical structure obstacles and (4) facili0es obstacles. The survey was administered electronical via email to all North American Program and Medical Directors listed in the 2020 AACO directory.

Results: The OCESO was administered anonymously to 20 orthop0c program directors and 16 medical directors. The response rate from program directors was 65% and 18% from medical directors.

Conclusion: The analysis showed that orthop0c program directors felt that the most significant obstacles to orthop0c training was dedicated 0me for teaching and department support. However, con0nuity between programs and formalized assessment techniques were also iden0fied as barriers to clinical teaching.

The Flipped Classroom Approach to Teaching Basic Science Classes in Orthop6c Fellowship Dusty Gronemyer, CO, Kim Merrill, CO, Jessica Tegeler, CO 2:15 PM - 2:30 PM Introduc0on: Over the last year, orthop0c fellowship students across the country were able to join a virtual Basic Science Course. This course used the google classroom plarorm that served as a database for pre-recorded lectures, videos, and other reading material. The class met weekly by means of zoom for virtual learning. We u0lized a flipped classroom approach. This involves watching pre-recorded lectures, videos and/or reading material at home followed by group learning. This study evaluates the flipped classroom model compared tradi0on classroom learning.

Methods: Orthop0c fellows and lecturers completed a ques0onnaire. Ques0ons were asked/answered using matrix ques0on lis0ng all topics to date with Likert scale. They were asked evalua0on ques0ons with key indicators about the topics, par0cipa0on, and sa0sfac0on about virtual learning.

Results: Among the orthop0c fellowship par0cipants the flipped classroom resulted in greater connec0on with other students. Other advantages included being more interac0ve and engaging while incen0vizing beWer classroom prepara0on.

Conclusion/Relevance: The flipped classroom method was received favorably by orthop0c fellows and may complement tradi0onal methods of teaching.

References: Cabrera MT, Yanovitch TL, Gandhi NG, Ding L, Enyedi LB. The flipped-classroom approach to teaching horizontal strabismus in ophthalmology residency: a pilot study. J AAPOS. 2019;23(4):200 e201-200 e206.

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AACO Scientific Session II Abstracts Sunday, November 14th, 2021

3:30 PM – 4:30 PM

Single horizontal rectus muscle ver6cal augmented transposi6on with posterior fixa6on suture in management of monocular eleva6on deficiency. Federico Velez, MD 3:30 - 3:45 PM We describe successful management of three cases of acquired monocular eleva0on deficiency (MED) with superior transposi0on of the lateral rectus augmented with a posterior fixa0on suture with or without simultaneous inferior rectus muscle weakening. In each case, the lateral rectus muscle was transposed superiorly to the superior rectus muscle along the spiral of Tillaux, with maintained distance between the original lateral rectus muscle poles and the limbus. Augmenta0on was achieved with a posterior fixa0on suture 8 mm posterior to the muscles' inser0on. At the 0me of lateral rectus transposi0on, simultaneous inferior rectus recession by 5.5 mm was performed in case 1 whereas simultaneous botulinum toxin injec0on was performed in case 3. With regards to all three cases, the mean age was 32 years [10-46 years] and the mean follow-up period was 10 months. The mean hypotropia was reduced from 35 prism diopters (PD) (range: 20 to 60 PD) to 4.67 PD (range: 0 to 14 PD) with a mean correc0on of 32.57 ± 9.34 PD ajer 9 months. In our experience, full-tendon-width transposi0on of the lateral rectus to the superior rectus with posterior fixa0on suture corrects primary posi0on hypotropia in MED and does not always require simultaneous inferior rectus recession. When transposing the lateral rectus muscle along the spiral of Tillaux, the measured distance of the original muscle inser0on point to the limbus must be maintained in order to prevent recession of the muscle.

Inter-observer reliability of the prism vergence test Alexandra Sherven, OC(C) 3:45 PM-4:00 PM Prism vergences are used to assess a pa0ent’s fusional abili0es. A prism introduces peripheral re0nal disparity and s0mulates the vergence system to make a motor movement to regain fusion. The inability to overcome prism results in a diplopic image or suppression. Inter-observer reliability for this test must be high as it is ojen used as a screening tool and it is important for trained professionals to reliably iden0fy whether a pa0ent has overcome a prism as proof of peripheral fusion. The purpose of this study was to iden0fy the level of inter-observer reliability between observers judging whether a subject’s response to a 20 base out prism was posi0ve or nega0ve. Methods: There were two groups of par0cipants; pa0ent par0cipants and inter-observer par0cipants. The pa0ent par0cipants included individuals who were eye care pa0ents at Saskatoon City Hospital and were either orthophoric or had a manifest angle less than 10 prism diopters. With their consent, these par0cipants were filmed performing the 20 base out prism test. Each video was then shown to professionals aWending either the TCOS Scien0fic Session or the AACO Scien0fic Session in 2019. The inter-observer par0cipants electronically indicated whether they believed the pa0ent was able to overcome the 20 base out prism or showed a nega0ve response. Addi0onally, inter-observer par0cipants occupa0on, years of experience, frequency and confidence in performing the 20 base out prism vergence test was collected. There were sixty- six inter-observer par0cipants’ altogether, twenty-three par0cipants from the TCOS scien0fic session and forty-three from the AACO scien0fic session. Results: Overall, for the sixty-six inter-observers, reliability was found to be 33%. Agreeability between the TCOS and AACO Scien0fic Session were found to be similar with 32% and 30% agreeability, respec0vely. In regards to years if work experience and agreeability, individuals in their first five years of prac0ce had the highest agreeability of 38%. Furthermore, par0cipants who u0lized the test 10 or more 0mes a week and had the most confidence showed were the most agreeable at 44%. Conclusion: This research study found there was very low inter-observer reliability amongst trained observers for the 20 base out prism vergence test.

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Is there agreement between near and distance fixa6on for secondary posi6on measurements? Jocelyn Zurevinsky, OC(C) 4:00 PM - 4:15 PM The North American standard is to measure cardinal posi0ons for distance fixa0on because it negates the effects of the near response, as well as those of proximal and voluntary convergence, and is more representa0ve of the devia0on that the parents see during real life and that the pa0ent sees in the mirror. It may be valuable to be able to take diagnos0c measurements at near fixa0on in situa0ons where distance fixa0on is not possible, such as in outreach clinics, at the bedside, when the distance vision is reduced, when premium 20 foot exam lanes are not available, or when it is not possible to engage the child’s aWen0on with a distance target. This pilot study inves0gated the agreement between secondary measurements taken with near fixa0on to those using distance fixa0on. Methods: Pa0ents from the clinic of the Saskatoon City Hospital Eye Care Center with intermiWent exotropia who were able to cooperate for both sets of measurements were enrolled. Measurements were taken in primary, up, down, right and lej gazes for distance fixa0on. In order to standardize right and lej gaze posi0ons, the pa0ent sat squarely in the chair facing straight ahead, and the chair was turned to 25 degree marks on the floor. Up and down gazes were not standardized for distance. For near fixa0on, targets were placed at 25 degrees from primary in all secondary direc0ons for fixa0on at ¾ of a meter. The same orthop0st took all measurements, beginning with distance fixa0on each 0me. Measurements were assessed for the presence of >10PD of change in right gaze or lej gaze in comparison to primary, as well as for >15 PD of increase in XT in upgaze, or 10PD increase of XT in downgaze as compared to primary or the opposite gaze (ie looking for an A or V paWern). Results: Five pa0ents were found to have agreement between near and distance (ie either no paWern or change on side gaze; or the devia0on changed on the same gaze for both; or there was an A or V present at both distances). The measurements for the remaining 10 pa0ents failed to reveal the same presence/absence of change in side gazes or paWerns. Conclusion: This pilot study suggests a lack of agreement between secondary posi0on measurements when taken at near versus distance. Based on the findings of the study, further study would require >1000 pa0ents to have significant power to detect a true rela0onship. The author suggests a repeat pilot study with a more homogenous pa0ent popula0on and a different posi0oning for pa0ent and fixa0on target.

AACO Scientific Session III Abstracts Monday, November 15th, 2021

11:00 AM – 12:15 PM

Levels of As6gma6sm and Anisometropia in Congenital Ptosis Kaajal Nanda, BMed. Sci., CO, Jenny Yu, MD 11:00 AM - 11:15 AM Purpose: To iden0fy a correla0on between the degree of congenital ptosis and levels of refrac0ve error, visual s0mulus depriva0on and refrac0ve amblyopia, and any changes with surgical interven0on. Methods: A prospec0ve inves0ga0on of 30 pa0ents aged 3 months to 8 years, from 2018 to 2021, with a diagnosis of congenital ptosis. Demographic data was documented and a full orthop0c assessment and cycloplegic refrac0on was performed. All tests were performed in a pre-defined order. Pa0ents requiring surgical interven0on for ptosis was at surgeon discre0on, and these pa0ents were monitored and included as part of the study. We did not interfere with the standardized care of these pa0ents.

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Results: The mean age at presenta0on was 27.1 months. The most affected eye was the lej eye. The prevalence of amblyopia ranged from 19.2-29.4%. There is no clinical significance of the type of amblyopia; refrac0ve, s0mulus depriva0on or both types, but those with s0mulus depriva0on amblyopia generally appeared to have poorer visual acui0es. There was no significant difference found in the levels of as0gma0sm throughout the follow up period, in surgical and non-surgical pa0ents. There was a significant improvement in the visual acuity of the affected eye (p=0.01) and no significant difference with both eyes open (p=0.06) in non-surgical pa0ents. Age-matched surgical pa0ents did not have significantly more as0gma0sm than non-surgical pa0ents, but did have significantly smaller palpebral fissures and MRD, p=0.004, p=0.05. There was a significant improvement of stereopsis (p=0.01), in those pa0ents who were able to perform the Frisby stereotest. Conclusion: We recommend conserva0ve management of congenital ptosis in most cases, unless there are clinically significant palpebral fissure measurements, MRD, poor levator func0on and/or a head posture present. Even in cases where surgery is delayed, pa0ents with congenital ptosis must be followed closely given the high risk of amblyopia.

Ocular Findings Associated with the L1CAM Muta6on Katrina Callus, BA, COT, OSC 11:15AM - 11:30 AM L1 cell adhesion molecule muta0on (L1CAM) is a rare, gene0c condi0on typically presen0ng in males. A muta0on of this gene may lead to a number of syndromes diagnosed in childhood, including MASA syndrome (mental disabili0es, aphasia, spas0city, adducted thumbs) and HSAS syndrome (hydrocephalus, spas0city in muscles, adducted thumbs, and aqueduct of Sylvius stenosis). Very liWle is known about L1CAM muta0on’s effects on ocular mo0lity. Four case studies from our ins0tu0on will be highlighted. So far, nystagmus, strabismus, oblique overac0on, and lid fissure synkinesis have been observed in the presence of this muta0on. The purpose of this presenta0on is to shed light on the L1CAM muta0on and possible associated ocular findings, in hopes of encouraging further research as an organiza0on.

How Much Strabismus Can You Have and Become a Pilot in the Air Force? Rhea Nelson, CO 11:30 AM - 11:45 AM This is case presenta0on of a young adult with strabismus trying to become a pilot in the United States Air Force (USAF). The presenta0on will discuss strabismus qualifica0ons required to apply as well as the pa0ent’s ini0al plan and outcome including all prior exams, evalua0on and management. Ajer successful interven0on, pa0ent is currently awai0ng the USAF admiWance exam.

Crescendo - Decrescendo Ka6e Tullar, 2nd year Orthop6c Student 11:45 AM - 12:00 PM A case presenta0on on an acquired form of periodic alterna0ng nystagmus. Periodic alterna0ng nystagmus is a rare form of nystagmus that can be congenital or acquired. This case focuses on a 31-year-old pa0ent who presented to clinic with common characteris0cs of this unique form of nystagmus. This case will discuss the epidemiology & e0ology of periodic alterna0ng nystagmus in detail.

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52nd Annual Richard G. Scobee, MD Memorial LectureMonday, November 15th, 2021

12:30 PM – 1:30 PM

Scobee Lecturer: Stephen Chris6ansen MD

Dr. Richard Scobee was the founder and first editor of the American Orthop0c Journal, and an ardent promoter of orthop0c educa0on in the early days of American orthop0cs. Today I have the honor of introducing an ophthalmologist who, like Dr. Scobee, has been a valued supporter of orthop0cs throughout his career: Dr. Stephen Chris0ansen.

Dr. Chris0ansen currently serves on the American Orthop0c Council, previously chairing the AOC Program CommiWee, and serving on the Examina0on CommiWee since 2015. He is the current president of the Journal of Binocular Vision and Ocular Mo0lity and past member of the American Orthop0c Journal Editorial Board. While at the University of MN, Dr. Chris0ansen served as the orthop0c program medical director, suppor0ng program director, Kim Merrill in the training of new orthop0sts. Dr. Chris0ansen is no stranger to the AACO, readily sharing his knowledge at our scien0fic sessions, courses and symposia for three decades. His career has taken him to academic ins0tu0ons in LiWle Rock and Minneapolis, and currently Boston where he has previously worked or currently works with a number of fortunate and wonderful orthop0sts who, in turn, deeply enrich the AACO and their orthop0c profession.

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Following a short career in the general prac0ce of internal medicine, Dr. Chris0ansen pursued an ophthalmology residency followed by a fellowship in pediatric ophthalmology at the Bascom Palmer Eye Ins0tute in Miami. Since 1991, he has forged a career in pa0ent care and academics, with university faculty posi0ons in Arkansas and Minnesota. Today, Dr. Chris0ansen is Professor and Chair of the Department of Ophthalmology and Pediatrics at Boston University School of Medicine, and Chief of Ophthalmology at Boston Medical Center.

Dr. Chris0ansen’s interests in pediatric ophthalmology and strabismus are wide and varied. He has published and presented extensively on eye muscle morphology and physiology, specifically, the effects of various pharmacologic agents on extra-ocular muscle. Other areas of study include ROP and other condi0ons associated with low birth weight infants, infan0le cataracts, and various childhood syndromes to name a few. His bibliography includes over 70 original ar0cles in refereed journals, over 50 refereed presenta0ons for numerous ophthalmologic organiza0ons, and over 160 invited presenta0ons and lectures on a vast interna0onal scale. For over two decades he has contributed to PEDIG through several leadership roles and clinical par0cipa0on. His achievements have been recognized over the span of his career, receiving many awards, most recently the cherished AAO and the AAPOS Senior Honor Awards.

Dr. Chris0ansen and his wife, Karen, have raised four children, and their family con0nues to grow with in-laws and grandchildren. World travel and explora0on are part of the Chris0ansen nature. In fact, one of his contribu0ons to pediatric ophthalmology is his service on medical missions abroad. From the start of his medical career, Dr. Chris0ansen has par0cipated in over twenty overseas mission trips, mostly to Africa—Zaire, Zimbabwe, Rwanda and Lesotho. His passion for African mission work has deep roots in his childhood years. Dr. Chris0ansen was raised in Zimbabwe by missionary parents from his early childhood through high school. Our own Jennifer Lambert recently shared this regarding her employer: “What Steve will be known for aCer he re9res is his commitment to medical missions and interna9onal partnerships with hospitals that have created opportuni9es for faculty, trainees, and researchers to broaden the scope of their purpose and work. This will be his legacy and it will be felt for years to come.”

On behalf of the Richard G. Scobee Memorial CommiWee and the AACO membership, it is my honor to announce the 52nd Richard G. Scobee Memorial Lecture en0tled, “Extraocular Muscle: The Dynamic Motor in Ocular Motor Disorders” by Dr. Stephen Chris0ansen.

Judy Petrunak Higgins Chair, AACO Richard G. Scobee Memorial CommiWee

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2021 Richard G. Scobee Lecture Abstract

“Extraocular Muscle: The Dynamic Motor in Ocular Motor Disorders” Dr. Stephen Christiansen

Normal ocular motor phenomena (gaze, versions, duc0ons, saccades, pursuit, VOR) and abnormal ocular motor disorders (nystagmus, strabismus, paresis, ophthalmoplegia) occupy the large por0on of every orthop0st’s and strabismus specialist’s clinical aWen0on. And, while the extraocular muscle (EOM) is the final common pathway of a highly complex system of ocular motor control, few of us are well acquainted with this amazing and fascina0ng end-organ that subtends ocular mo0lity. While EOM shares many characteris0cs with other skeletal muscles, it is uniquely suited for the demands of binocularity, alignment, gaze stability, micro and macro saccades, and smooth pursuit. It is the fastest of all the skeletal muscles; it has unique myosins and fiber types; and it has a highly complex motor feedback loop that is both visual and propriocep0ve. Just as unique are the embryologic origins of EOM, an understanding of which is beginning to inform not just new diagnos0c en00es but new therapeu0c direc0ons for the treatment of strabismus, injury, dystrophy, and other myopathies. The tools in the toolbox of future strabismus specialists will look much different than what we “modern” clinicians currently employ. The goal of this presenta0on is to both expand our understanding of EOM and to consider ways that the unique characteris0cs of EOM might be leveraged to develop new treatments for ocular mo0lity disorders.

AACO Scientific Session IV Abstracts Monday November 15th, 2021

2:30 PM – 3:45 PM

Moebius Syndrome with Aberrant Convergence Shelley Klein, CO, COMT 2:30 PM - 2:45 PM Classic Moebius Syndrome is a rare non-progressive congenital disorder affec0ng CN VI and CN VII. Children typically present with an inability to form facial expressions and decreased abduc0on. There are many other deficiencies associated with Moebius Syndrome such as an inability to close the eyelids, difficulty sucking or chewing, limb defects and other cranial nerve involvement. A unique Moebius Syndrome case will be presented with aberrant convergence.

Inferior Oblique Over-Ac6on a^er Cranial Nerve Six Palsy Gabriella Waldusky, Orthop0c Student, Kim Merrill, CO 2:45 PM - 3:00 PM Chart review study of pa0ents with a diagnosis of cranial nerve six palsy for the appearance of inferior oblique over ac0on (IOOA). Chart review going back to 2010 with expected review of about 120 pa0ents’ charts expected. We plan to collect the following data: sensorimotor examina0on, age, cause of sixth nerve palsy, other ophthalmic diagnoses, 0me to resolu0on of sixth nerve palsy, neuroimaging and orbital imaging studies, and any surgical interven0ons. We hope to build on the work (unpublished) of Dr. Culican looking at the development of IOOA ajer cranial nerve six palsy, to determine if IOOA is correlated to the level of residual esotropia, and to evaluate other characteris0cs’ rela0onship to the development of IOOA (such as pa0ent age or 0me to resolu0on of cranial nerve six palsy). As e0ology of this observed phenomenon is s0ll debated, we plan to look at any available orbital imaging for any visible pulley shij to explain IOOA

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Interpreta6on and Management of Acquired Convergence Dysfunc6on Gill Roper-Hall, DBOT, CO 3:00 PM - 3:30 PM

Introduc0on: Acquired convergence dysfunc0on ojen presents in a neuro-ophthalmology prac0ce. The spectrum of dysfunc0on ranges from convergence paralysis or paresis from various causes, ojen concussion, to mild or severe exer0on of convergence in spasm of the near reflex. As convergence is a voluntary func0on, the cogni0ve status or degree of effort in an individual can affect interpreta0on and management.

Methods: Examina0on and management techniques for pa0ents with acquired convergence dysfunc0on will be described. Standard convergence therapy should be modified in pa0ents with convergence paresis in the post-concussion syndrome. At the other extreme, convergence spasm can be challenging to treat. Subtle convergence spasm may be superimposed on other findings (underlying refrac0ve error, small ocular devia0on) and confound the diagnosis. Iden0fying these findings will contribute to correct management. While textbooks advocate the use of cycloplegia or even psychiatric referral in cases of overt convergence spasm, simpler methods may be applied with successful outcomes.

Case reports: Convergence spasm following concussion is a rare finding; three cases will be presented.

Conclusion: It is important to differen0ate between convergence weakness or insufficiency and true convergence paresis. Management should be modified in pa0ents with post-concussion syndrome. Recognizing that convergence spasm can present in a more subtle form may assist in differen0al diagnosis and management; some simple management techniques can help.

AACO Scientific Session V Abstracts Monday November 15th, 2021

4:00 – 5:00 PM

Norma6ve Values, Testability, and Validity for a New Preferen6al Looking Stereoacuity Test Sarah Morale, BS 4:00 PM - 4:15 PM Introduc6on: Age norms and testability for 3–5 year old children have been reported for the PASS III stereotest using a poin0ng response. We aimed to expand the norma0ve data to children as young as 6 months, assess testability, and evaluate validity use of the PASS III as a preferen0al-looking test for younger children and children with special needs. Methods: 68 control children, 362 children with eye condi0ons, and 167 children with special needs were tested with the PASS III. Percent testable was calculated for children with and without special needs, normal tolerance limits were determined, and test validity was assessed. Results: In controls, mean PASS III stereoacuity improved from 371 arcsec at 12 months to 174 arcsec at 24 months, and 87 arcsec at 36 months. Testability in the 12, 24, and 36 months age groups were 81%, 87%, and 97% respec0vely and 92% for special needs children. Comparison to previously published norms and tes0ng in a known nil stereoacuity cohort supported PASS III test validity. Compared to gold standard stereoacuity tests, accuracy of the PASS was 89%. Conclusion: Overall, preferen0al-looking tests using the PASS III provide a sensi0ve and specific measure of stereoacuity

with high testability for young children and children with special needs.

Reliability of Visual Acuity Using the Home Vision Check Kit Developed at the University of Minnesota Anna Schweigert, CO 4:15 PM - 4:30 PM Purpose: Virtual pediatric ophthalmological examina0ons ojen require accurate visual acuity (VA). We developed a user-friendly Home Vision Check Kit (HVCK) for this purpose. The aim of this study was to validate the children’s VA assessed at home using the HVCK compared to the VA obtained in clinic by experienced examiners. Methods: We iden0fied 3-8 year-old par0cipants who could recognize optotypes. Par0cipants’ parents/guardians received the HVCK including step-by-step instruc0ons and the material needed for the vision test. Parents/guardians

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measured the par0cipants’ vision at home using the same optotype used in clinic within three days, recorded it and mailed us the results using a ques0onnaire in a pre-paid envelope. Results: From 104 par0cipants, we received 36 results. Four forms were excluded as two came in unlabeled and two were tested incorrectly (without glasses). VA of 3 eyes was recorded as “unable” (age 3). VA of 60 eyes met the inclusion criteria. VA tested at home was obtained and compared to the VA in clinic, the HVCK VA was equal or within one-line in 43 eyes (ages 3-8), 2 lines worse in the HVCK in 7 eyes (ages 3-5, 8), ≥3 lines worse in the HVCK in 8 eyes (ages 4-5, 8), ≥3 lines beWer in the HVCK in 2 eyes (age 6). Thirty-three parents/guardians rated test usability: 3 “difficult”, 4 “fine”, and 26 “easy” or “very easy”. Child’s coopera0on ra0ngs were: 3 “uncoopera0ve”, 4 “acceptable”, 26 “good coopera0on”. Conclusion: HVCK was consistent for 43 eyes (71.6%) with ≤1-line difference compared to VA in clinic. HCVK was unlikely to over-es0mate VA. Overall, the HCVK displayed fair reliability. Despite enthusiasm in clinic and follow-up phone calls, response rate was poor (34.6%), resul0ng in low sample size (34). Clinic follow-up should be considered for pa0ents with >1 line VA disparity using HVCK compared to the last in-clinic examina0on.

Graded Marginal Myotomy for Minimally Overac6ng Inferior Oblique Jonathan Russell, CO, MBA 4:30 PM - 4:45 PM Purpose: To gauge the effec0veness of inferior oblique marginal myotomy procedure for mild inferior oblique overac0on (≤ +2 ) with small incomitant hypertropia and compare the surgical efficacy of a graded marginal myotomy (small vs large) of inferior oblique muscle. Methods: Retrospec0ve chart review of all pa0ents with intermiWent exotropia with small angle incomitant hypertropia who had surgery from July 2017 to July 2019. This easy procedure can be performed with a low temp handheld electrocautery in less than 5 minutes and comprises of a single cautery incision from the anterior edge of muscle extending through 2/3rd of the muscle width (small marginal myotomy, v myotomy) and a similar second cautery incision 5 mm from the first incision star0ng from the posterior edge of the muscle and extending through 2/3rd of the muscle width (large marginal myotomy, tradi0onal z-myotomy) Results: In Group 1 (pa0ents undergoing V-myotomy), mean preopera0ve hypertropia in primary gaze and contralateral gaze of ac0on was 2.85 PD and 6.54 PD respec0vely. The mean postopera0ve devia0on in primary posi0on and contralateral gaze was 0.29 PD and 1.67 PD. In Group 2 (Z-myotomy), mean preopera0ve hypertropia in primary gaze and contralateral gaze of ac0on was 6.55 PD and 10.17 PD respec0vely. The mean postopera0ve devia0on in primary posi0on and contralateral gaze was 1.26 PD and 3.41 PD respec0vely. The mean follow-up period was 31.23 months (range 10-52 months). Conclusion: Graded Inferior Oblique Marginal Myotomy is an excellent addi0on to our exis0ng armamentarium of Inferior oblique weakening procedures. It offers a safe, easy, effec0ve sutureless alterna0ve to weakening a minimally overac0ve inferior oblique muscle with small angle incomitant hypertropia with minimal risk of overcorrec0on.

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ON DEMAND Access to on-demand content will be available through the Online Learning Center

ajer the live sessions have ended.

AAO/AOC/AACO Sunday Symposium

Course Title: AAO/AOC/AACO Sunday Symposium

Time: On Demand Schedule & Speakers:

3 minutes Introduc0on (Alex Christoff CO/ Mark Borchert, MD) 12 minutes E0ology and Evalua0on of Acquired Diplopia in Adults Seen by an Orthop0st Over a 3 Year Period (Alex

Christoff, CO) 7 minutes Evalua0on and Management of CI (Lisa Rovick, CO, PhD) 22 mintues Evalua0on and Management of Divergence Insufficiency (Jonathan Holmes, MD) 9 minutes Evalua0on and Management of Heavy Eye Syndrome (Stacy Pineles, MD) 12 minutes Evalua0on and Management of Acquired, Symptoma0c Ver0cal Strabismus (Mike Siatkowski, MD) 11 minutes Wrap-up and discussion (Alex Christoff CO/ Mark Borchert, MD)

Course Descrip6on:

1. Proposed 0tle: “Double Trouble: Acquired Diplopia in Adults.”

2. Proposed audience: Orthop0sts, comprehensive ophthalmologists, pediatric ophthalmologists

3. Ra0onale: Diplopia (double vision) is a common symptom iden0fied in older ophthalmological and neurological pa0ents, frequently occurring in individuals with no prior history of strabismus who then develop an ocular misalignment ajer visual maturity (1, 2). With many underlying causes, evalua0on of adult pa0ents with acquired diplopia is a diagnos0c challenge. Efficient management implies an accurate diagnosis ajer obtaining a detailed history and a careful clinical examina0on (3). Assessment of the pa0ent’s perceived diplopia must exclude other symptoms that can be misunderstood by the pa0ent, including visual distor0on from re0nal disease, visual field defects, ajer images, and visual hallucina0ons. Treatment of diplopia should be according to the cause, with a goal of regaining and maintaining single binocular vision, and in the long term, providing treatment of the pathology that caused it, whenever possible. In this course, experts will share e0ologies, history-taking strategies, discuss medical workup for the common causes of strabismus and acquired diplopia in adults, and describe treatment op0ons, both non-surgical and surgical, for this poten0ally perplexing, challenging subset of pa0ents.

References: 1. PraW-Johnson J, Tillson G. Why Does the Pa0ent Have Double Vision? Management of Strabismus and

Amblyopia: A Prac0cal Guide. New York, NY Thieme Medical Publisher, Inc1994;242- 246 2. von Noorden G Binocular vision and space percep0on. Binocular Vision and Ocular Mo0lity. 5th St Louis,

Mo Mosby–Yearbook Inc1996;8- 40 3. Gräf M, Lorenz B. How to deal with diplopia. Rev Neurol. 2012;168(10):720–728

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Continuing Education Credit Information

Please visit the AACO Website for the most up-to-date informa0on regarding the number of available CE credits.

Course evalua0ons will be conducted electronically this year. Visit the Online Learning Center for survey links.

AACO Mee0ng Site hWps://aaco.memberclicks.net/2021-na0onal-mee0ng Online Learning Center: hWps://aaco.mclms.net/en/

AOC - AOC credit is available for both the livestream and the recorded sessions, including the on-demand Sunday Symposium. Recordings of each live session will be available through the Online Learning Center ajer the mee0ng has ended. AOC requires each aWendee to record 3 knowledge points per hour, i.e. something you learned or informa0on presented during the lecture. Please keep your knowledge points to submit along with your recer0fica0on - they do not need to be turned in to the mee0ng organizers. An op9onal form is available to download from the Online Learning Center to record your knowledge points - you may also use your own paper or electronic document.

IJCAHPO - IJCAHPO credit is available for the livestream sessions only. Due to their virtual program policies, no IJCAHPO credit is available for the recorded or On-Demand sessions. AWendance of 3 or more hours for the en0re mee0ng must be recorded in order to receive credit - this is in lieu of the quizzes that were required last year. AWendance will be recorded using Google Forms submissions during the live sessions. There are no quizzes available for those who do not log aWendance - please make sure to plan accordingly if you would like IJCAHPO credit.

To receive credit: AOC • AWend live or view recorded and On-Demand sessions • Record 3 knowledge points per hour (keep for your records) • Complete Course Evalua0on Surveys

IJCAHPO • View live sessions ONLY • Record your aWendance at each session (look for the survey links in the chat) • Complete Course Evalua0on Surveys

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AACO Officers and Representatives

Execu6ve Commiiee President Alex Christoff Vice President Laura Kirkeby Secretary Nina Apple Treasurer Alicia Baird Past President Shelley Klein

Board of Directors Director of Finance Kimberley Beaudet Eastern Regional Representa0ve Jennifer Lambert Midwest Regional Representa0ve Laura May Southern Regional Representa0ve Anthony Yamarino Western Regional Representa0ve Sally Murray AOC Elected Representa0ves Pam Houston & Emily Miyazaki IOA Representa0ve Sheila Chamberlin JCAHPO Representa0ve Sarah Whitecross AAP Representa0ve Jennifer Lambert

2020-2021 Committee Chairpersons Bylaws Mary DeYoung-Smith Educa0on Dusty Stolz-Gronemyer Ethics Kimberley Beaudet Finance Kimberley Beaudet Fundraising Hilary Walsh Historical Wanda Pfeifer Honor Cer0ficate Emily Miyazaki Instruc0on Laura Kirkeby Jean Robinson Library Samantha Pape Lancaster Award Bruce Furr Membership Megan Evans NewsleWer Gill Roper-Hall Nomina0ng PaWye Jenkins Prac0ce Management Beth Colon Program Amanda Yonkers Public Rela0ons Marlo Galli & Samantha Pape Registra0on Julie Harmon Scobee Memorial Judy Petrunak Straight Scoop Chantel Devould-Henderson Student Advisory / New CO’s Philip Villanueva & Anthony Yamarino Tribute Randi Zuller Vision Screening Pamela Berg Website Jorie Jackson & Sally Murray

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Ad-Hoc Commiiees AACO Long Range Planning Paula Edelman Interna0onal Affairs Laura Hodges Membership Expansion Gill Roper-Hall, Jennifer Lambert, Paula Cashman Re0red Orthop0st Outreach Gill Roper-Hall Early Career Orthop0st Group Rachael Jenkins

Index of Authors

Name Page Arnoldi, Kyle, CO 3, 8 Biernacki, Ron, CO 3, 8 Bishop, Kaila OC(C) COMT 3, 9 Borchert, Mark, MD 19 Callus, Katrina, BA, COT, OSC 5, 13 Carr, Jessica OC(C) COMT 3, 9 Chris0ansen, Stephen, MD 5, 14 Christoff, Alex, CO 19 Colpa, Linda OC(C) 3, 8 Edmond, Jane, MD 3, 8 Ellis, George S. Jr, MD 3, 9 Fredrick, Douglas, MD 4, 9 Gronemyer, Dusty, CO, 4, 9, 10 Heidary, Gena, MD PhD 3, 9 Holmes, Jonathan, MD 19 Hundley, Peyton 3, 9 Klein, Shelley, CO, COMT 5, 16 Kushner, Burton, MD 3, 8 Magwire, Kristyn CO 3, 9 Merrill, Kim, CO 4, 5 , 10, 16 Morale, Sarah, BS 5, 17 Murray, Sally, CO 3, 8 Nanda, Kaajal, BMed Sci, CO 3, 5, 8, 12 Nelson, Rhea, CO 5, 13 Pfeifer, Wanda OC(C),COMT,CO 4, 9, 10 Pineles, Stacy, MD 19 Pritchard, Cindy, CO 3, 8, 9

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Reynolds, Jim, MD 3, 8 Roper-Hall, Gill, DBOT, CO 5, 17 Rovick, Lisa, CO, PhD 19 Russell, Jonathan, CO, MBA 5, 18 Samaha, Reeves Ellis, MD, MPH 3, 9 Schweigert, Anna, CO 5, 17 Sherven, Alexandra, OC(C) 4, 11 Siatkowski, Mike, MD 19 Strominger, Mitch, MD 3, 8 Tegeler, Jessica, CO 4, 10 Ton, Veronica COA 3, 9 Tullar, Ka0e 5, 13 Velez, Federico MD 4, 11 Waldusky, Gabriella 5, 16 Yu, Jenny, MD 5,12 Zurevinksy, Jocelyn OC(C) 3, 4, 8, 12

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Save the Date - Future Meetings

February 12-17, 2022 Aus6n, TX NANOS - North American Neurology-Ophthalmology Society www.nanosweb.org

March 23 - 27, 2022 Scoisdale, AZ AAPOS Annual Mee0ng hWps://aapos.org/mee0ngs/annual-mee0ng2022

May 1-4, 2022 Denver, CO ARVO - Associa0on for Research in Vision and Ophthalmology hWps://www.arvo.org/annual-mee0ng/

June 9-12, 2022 Halifax, Nova Sco6a TCOS and COS Annual Mee0ng hWps://www.cosprc.ca/2022-cos-annual-mee0ng-and-exhibi0on/ www.tcos.ca

June 9-12, 2022 Liverpool, UK 14th IOA Interna0onal Orthop0c Congress hWps://ioacongress.org/

June 2022 Portland, OR AACO Joint Western / Midwest Regional Mee0ng www.orthop0cs.org

September 9-12, 2022 TBD World Ophthalmology Congress hWps://icowoc.org/woc2022/

September 30-October 3, 2022 Chicago, IL AAO / AACO Na0onal Mee0ng McCormick Place hWps://www.aao.org/annual-mee0ng/past-and-future-mee0ngs

www.orthop0cs.org

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2021 AACO Sponsors

Thank you to the following sponsors for their generous support of the AACO 2021 National Meeting:

Fresnel Prism & Lens Co. http://www.fresnel-prism.com/

Miraflex www.miraflex.com

Thank you to FOREA, Peter Montana and Vision of Light for their support of TWO Orthoptist Speakers at this year’s meeting! Congratulations to the 2021 AACO Travel Grant recipients:

Kaajal Nanda, BMed Sci, CO Rhea Nelson, CO

For information on the 2022 Travel Grant, visit http://forea.net/educational-travel-grant/

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